Provider Demographics
NPI:1184909574
Name:COUNSELING AND ASSESSMENT CENTER, LLC
Entity type:Organization
Organization Name:COUNSELING AND ASSESSMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROTH-LAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-971-5797
Mailing Address - Street 1:636 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4836
Mailing Address - Country:US
Mailing Address - Phone:314-971-5797
Mailing Address - Fax:888-224-4141
Practice Address - Street 1:300 OZARK TRAIL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2166
Practice Address - Country:US
Practice Address - Phone:314-971-5797
Practice Address - Fax:888-224-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028635251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health